251. Peds MSK + Sports Med Flashcards
How to classify growth plate injuries?
Salter-Harris Classification
I. Separation through physis (subtle widening)
II. Above physis (metaphysis) and through physis: most common growth plate fracture, I+II do not affect growth
III. beLow physis (epiphysis) and through physis
IV. Through physis, epiphysis, metaphysis
V. cRush injury to physis - most severe, worst prognosis
What are the 4 fracture patterns of bone and their mechanisms?
- Transverse: perpendicular to long access, due to direct blow/bending force
- Comminuted: tons of fractures, needs surgery, high force mechanism (car crash)
- Oblique: oblique to long axis, due to twisting/compression/bending
- Spiral: due to twisting (abuse or lands in a split)
What are the three ways of bone displacement?
- Translation: lateral movement (%)
- Angulation: through midaxial line (degree)
- Rotation: hard to see in hands
Buckle/Torus Fracture
cause, prognosis
Compression force on bone
common forearm fracture in kids, stable
Heals with simple immobilization 3-4wks
Nursemaid’s Elbow (Radial Head Subluxation)
Hx, PE, Mechanism, Tx
Traction to arm - pulling up
no swelling/tenderness, just pain on movement of elbow
most common elbow injury in kids 2-5yrs (25% of all elbow injury)
M: anular ligament gets trapped in joint space when radial head dislodges distally
T: Classic: supinate and flex to relocate radius or Hyperpronation (better success and less pain)
Greenstick Fracture (Mechanism, Look, Tx)
Compression/Bending force, bone on convex side fails (incomplete fracture)
Plastic deformity on concave side (Bowing)
To reduce, need to make break complete to realign!!
Toddler’s Fracture
what it is, mechanism, sx, tx
Oblique, non-displaced fracture of distal tibia
M: age<5, kid twists it while running/falling/trying to free leg
sx: limp, refuse to bare weight, subtle fracture on xray
tx: cast and no weight bearing!
Slipped Capital Femoral Epiphysis (SCFE)
What it is, Hx, XR, Tx, Complications
Growth plate instability during adolescence/puberty = salter I fracture, epiphysis slips inferior and posterior
Hx: subacute-chronic with acute worsening (slips even more), vague pain with limp
XR: WIDE growth plate (ice cream falling off cone)
Tx: surgery to prevent slippage
C: avascular necrosis of hip
Sinding-Larsen-Johansson Syndrome
What it is, what it is NOT, age, tx
Inferior patella apophysitis - irritation of accessory growth area
NOT quadriceps tendinopathy
Age: 11-12 y/o
Tx: sx tx, stretching, patellar strap
Osgood-Schlatter Sydrome
What it is, Epidemiology, Tx
Irritation of tibial apophysis - lump below knee
E: boys 12-15; girls 10-13 athletes in sports
tx: activity modification, ice, NSAIDs, patellar strap, immobilization, PT for stretching
Sever Disease
what it is, Epidemiology, What it isn’t, Sx
Calcaneal Apophysitis
Ages 8-11
NOT achilles tendinopathy/plantar fasciitis
Sx: weakness to dorsiflex, tight calf muscle
Anterior Superior Iliac Spine Apophysis Avulsion Fracture
What it is, Tx
Apophyseal irritation of ASIS - sartorius affected
Tx: rest, PT, return to sports in 6wks-4months
Little League Elbow
what it is, what it isn’t, Tx, Prevention
Medial Epicondyle Apophysitis (NOT medial epicondylitis - golfer’s elbow)
Tx: REST, PT
Prevention: Proper pitch progression (curve balls ages 14+), pitch counts and rest
Little League Shoulder
What it is, tx
Proximal Humerus Epiphysiolysis
Tx/Prevention similar to Little League Elbow
Two mechanisms for tendinopathy
- Mechanical Overload: repeated microdamage with inadequate healing, failed healing response, elevated inflammation
- Pro-Inflammatory Environment: sedentary individuals with high levels of pro-inflammatory cytokines, low levels of COL1 (usually improve inflammation)
